LAUSR

Introduction Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-specific liver disease, affecting around0.7% of pregnancies. It is a multifactorial condition with genetic, hormonal and environmental components. ICP is a diagnosis of exclusion, and guidelines often state that clinicians should test for viral and autoimmune causes of raised bile acids and liver transaminases. However, the detection rate for alternative diagnoses or co-morbidities is uncertain in the literature. Objective To assess the detection rate of new diagnoses of viral, autoimmune or ultrasonic abnormalities in women presenting with ICP. Methods All women with raised bile acid concentrations were identified over a 2-year period between 1 Jan 2016 and 31 Dec 2017 at a maternity unit in London, UK; electronic patients records were searched for additional investigations, and documentation around diagnoses. Results 324 women had a raised bile acid concentration (median 18 (IQR) 13–32  μ mol/L) at a median gestation age of 35.1 (IQR 32.0–37.1) weeks’ gestation at first presentation. 28.4% were tested for all liver function tests, virology and autoimmune tests. All positive results for hepatitis B surface antigen and hepatitis C IgG were previously known. No new diagnoses of EBV, CMV or hepatitis A were made. From a panel of autoimmune antibody testing, some positive results were found (at varying titres), but none led to a new diagnosis of liver disease. Varying liver (n = 26) and gall bladder (n = 43) pathology was noted on ultrasound, but none of new clinical significance. Discussion In our study cohort, there were no new co-existing abnormalities of clinical significance detected during additional investigations for ICP. Guidelines should review the evidence base and need for comprehensive screening of all women with ICP and consider whether a more targeted approach should be used, based on clinical symptomatology or unusual features.